Disc Herniation

The spinal disc is a soft 'cushion' between the bones of spinal vertebrae. Herniated disc is common in the lumbar spine, the part of the backbone between bottom of the ribs and hips.

The term 'herniate' means 'to bulge' or 'to stick out'. When disc herniation occurs, the cushion that sits between the spinal vertebrae is pushed outside its normal position. Disc herniation occurs when the spine presses on the nerves around the backbone. This is sometimes incorrectly referred to as ruptured or slipped disc.

Usually patients with back pain, leg pain, weakness of lower back muscles are diagnosed with a herniated disc.

What happens in disc herniation?

Chances are the spinal disc becomes rigid with age. While in young individuals the disc is soft and elastic, it tends to gradually lose its elasticity and become more vulnerable to injury. In about 30% of people, even in individuals around the age 30, MRI shows evidence of disc deterioration.

When the spinal disc becomes less elastic, it can rupture. The spinal nerves and spinal cord can become pinched when the herniated disc bulges out between the vertebrae. Certain activities like sitting, driving, bending or coughing and sneezing can worsen the pain as pressure is applied on the nerves when one makes movements.

• Disc herniation occurs in persons who have spinal stenosis, which is a problem that caused narrowing of space around the spinal cord and nerves.
  
  
• A herniated disc can occur suddenly or due to a fall or an accident.
  
  
• It can also occur quite gradually due to repetitive straining of the spine.
  
  

• When the spinal cord or spinal nerves gets compressed, abnormal signals can pass. Some common symptoms include:
  
  
  • Electric shock pain: Abnormal sensations, which can be experienced as electric shocks can occur due to nerve pressure.
    
    
  • Tingling and numbness can be experienced in the same manner in the regions where electric shocks sensations occur.
    
    
  • Muscle weakness, nerve irritation, interruptions of signals from the brain is common symptoms of disc herniation.
    
    
  • Bowel and bladder problems signal a possible condition 'cauda equine syndrome' resulting from herniated disc. There may be problems urinating or having bowel movements or numbness may be felt around the genitals. This is a medical emergency and the patient has to rush to the doctor immediately.
    
    
  • Back pain that spreads to the buttocks and legs, neck pain that can spread to the shoulder and upper arms occur with disc herniation.
    
    

Diagnosis for disc herniation

A medical practitioner examines the patient physically and tests for sensation, muscle strength and reflexes. MRI is commonly done to diagnose a herniated disc. The MRI may show abnormalities of the lumbar spine in people as they age. In patients in their twenties, MRI reveals signs of disc wear. Physical examination findings, MRI readings and X-ray opinions help the physician come up with a treatment plan for patients with a herniated disc.

Treatment options for disc herniation

Often the line of treatment depends on numerous factors including symptoms exhibited, age of the patient and activity level.

• The first option of treatment is rest and modification of patient activity. It is imperative to avoid activities that can aggravate the condition.
  
  
• Ice and heat applications can help relieve the pain and relax the muscles of the back. Muscle spasm can also be abated to some extent by this ice and heat therapy.
  
  
• Physical therapy includes a number of lumbar stabilization exercises that do not directly affect the herniated disc. Stronger and well balanced muscles can control the lumbar spine and minimize the risk of injury to the nerves in the disc.
  
  
• There are specific anti inflammatory medications that can help relieve pain associated with disc herniation. Oral steroids can also help in acute and sudden disc herniation. For severe and short term pain management, narcotic pain medications are prescribed. However, these medications can make the patient drowsy and can become addictive.
  
  
• Cortisone steroid can be administered directly in the area where the nerve compression has occurred. The idea here is to relieve the compression of the nerves.
  
  
• Surgical treatment of a herniated disc is recommended if there are significant neurological findings soon after the injury. With patients who show cauda equine syndrome, prompt surgical treatment would be needed.
  
  
  • Surgery removes the herniated disc and the space around the compressed nerve is freed. Surgery is done in straight forward cases through endoscopic or microscopic excision of the herniated disc.
    
    
  • The new procedure is called endoscopic discectomy; the surgeon uses a special instrument and a camera to remove the herniated disc by making very small incisions.
    
    

Recovery post surgery for a herniated disc

It may take several weeks for the pain to slowly dissipate after surgery for a herniated disc. Pain around incision is common. This can be controlled through medication. In some cases, a lumbar corset brace helps to relieve pain.

While gentle and mild activities like walking or sitting upright are encouraged after surgery, patients should avoid lifting heavy objects, bending or twisting the back. Strenuous exercises should also be avoided till such time advised by the doctor.

• Keep the back straight and only bend the knees and hips while lifting.
  
  
• An object can be held closely to the body.
  
  
• It would be better to put one foot on a small stool or box if standing for a long time.
  
  
• Avoid wearing high-heeled shoes.
  
  
• Never sleep on the stomach.